100157 IG� OV 5 I I.OT NO.
NO. STREET
W Z rA:PPLICION FOR BUILDING PERMIT
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W CITY OF CUPF.RTINO
� 1 Sanitary No.
i u Unite 'N 9 40 196_ Permit No. 0 Q
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W Application is hereby made fora it to
° ` CITY '
�m a�ntt � �s Z Building j
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W to be occupied only a 1 ce with
0 o Plans, Specifications and P -Plan file a ewlth. Pl Ck Fee
"; Estimated Value of Improvements, $ �Q Fee$
iJ It is hereby agreed that the requirements of the Cupertino Building and Zoning Ordinances and
J Z all other laws applicable to the construction, location, and use of buildings within the City of
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Cupertino will be complied with.
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Owner Address
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`u Phon 38 Approve
State Licensee BUILD NG INSPE.CI'OR